tbuckley/cabot-search huggingface dataset:
Abstract 14604: Arrhythmia Burden With Right-Heart Catheterization: A Systematic Review and Meta-Analysis
Authors: Saarwaani Vallabhajosyula, Nada Hafez, Omofolarin Babayale, Ahmed Elkhapery, Hemanth Krishna Boppana, Mallory Balmer-Swain
Journal: Circulation (2022)

Background: Current guidelines cite complete heart block as a complication of invasive hemodynamic monitoring. This was described to be higher in those with existing intraventricular conduction delays. The objective of this meta-analysis was to evaluate the true risk of arrhythmias and pacemaker implantation rates in patients undergoing right-heart catheterization or with pulmonary artery catheter use. Methods: A literature search was performed from inception until May 2022. Studies that reported incidence rates of arrhythmias in those undergoing right-heart catherization or with pulmonary catheter use, including right- (RBBB) and left-bundle branch (LBBB), were included. Some studies described the development of complete heart block (CHB) and need for pacing. Results: Six single-center studies were included in our analysis with a total of 8, 077 right-heart catheter insertions. All patients had continuous ECG monitoring. Most frequently reported arrhythmia was premature ventricular ectopy (56.4%). No fatal ventricular arrhythmias were described and when noted, RBBB was transient in nature (0.2%, n=12/7577). The risk of CHB was 12.8% (n=24) in those with pre-existing LBBB (n=187). Pacing needs were infrequently described, but when reported was 6.3% (n=10) of concordant CHB and LBBB (n=160), and this was 0.2% of all described LBBB patients (n=6292) ( Figure ). Conclusion: Most arrhythmias were benign and transient in nature. The risk of CHB requiring pacing needs was only 0.2%. This begs the question of true burden of the theoretical complication of CHB with invasive hemodynamic monitoring, and most evidence is from decades ago.
Abstract 14708: Cardiovascular Calcium Scoring by Deep Learning is Predictive of Mortality in Emergency Department Patients
Authors: Ding Yi Zhang, Maude Roberge, Rushali Gandhi, Yaman Zarour, Farida El Malt, Albert Shalmiev, Jordan Benzur, Mhd Diaa Chalati, Nissim Benizri, Neetika Bharaj, Marc Afilalo, Jonathan Afilalo
Journal: Circulation (2022)

Introduction: Computed tomography (CT) imaging is widely used in the emergency department (ED) setting. Calcifications of the coronary arteries, heart valves, and aorta are common incidental findings that may herald clinical or subclinical cardiovascular disease. Hypothesis: We sought to determine whether the quantitative burden of cardiovascular calcifications, as measured by a CT-based deep learning pipeline, would be predictive of short-term mortality in a diverse population of ED patients. Methods: We conducted a prospective single-center cohort study nested in the Quebec COVID-19 Biobank from March 2020 to September 2021. For the purposes of this study, we enlisted adult patients presenting to the ED with cardiopulmonary symptoms who were tested for COVID-19 and underwent CT imaging of the chest. We used a deep learning model previously developed by our team to automate the quantitative scoring of coronary artery calcification (CAC), aortic valve calcification (AVC), mitral annular calcification (MAC), and thoracic aorta calcification (TAC) from the CT images. These calcium scores were categorized as sex-stratified tertiles plus a zero-score referent category. The primary outcome was all-cause mortality at 30 and 90 days adjusted for age, sex, and COVID-19 status using multivariable logistic regression. Results: The study sample consisted of 731 ED visits among 271 unique patients with a mean age of 66 years and 47% females. COVID-19 illness was the main diagnosis in 29% of ED visits. The prevalence of any quantifiable calcification was 51% for CAC, 33% for AVC, 23% for MAC, and 80% for TAC. The statistically significant adjusted odds ratios for mortality were 2.50 (1.08, 5.81) in the highest AVC tertile at 30 days, 2.73 (1.37 5.47) in the highest CAC tertile at 90 days, and 4.42 (1.01, 19.4) in the highest TAC tertile at 90 days. These odds ratio remained similar after further adjustment for past history of myocardial infarction or heart failure. Conclusions: High calcium scores in the coronary arteries, aortic valve, and thoracic aorta are associated with heightened 30-day mortality in ED patients. Deep learning quantification of calcium scores from clinical CT scans is an opportunistic approach for risk stratification.
Abstract 14693: Venous Thromboembolism in the Modern Era of Multiple Myeloma : An Analysis of Real-World Data From a Nationwide Claims Database in Japan
Authors: TETSUYA SHIINA, Tomotaka Dohi, Hiroshi Ohtsu, Naohiro Yonemoto, Kazuhiro Sase, Tohru Minamino
Journal: Circulation (2022)

Introduction: Treatment for Multiple Myeloma (MM) with new therapeutic agents has dramatically improved outcomes and increased the number of survivors. Although venous thromboembolism (VTE) is common in MM, the pathophysiological interplay between VTE and MM, including risk factors related to the patient, disease, and modern treatments, is complex and incompletely understood. Objectives: To evaluate real-world data on the risk factors of VTE and outcomes of patients with MM using a nationwide claims database. Methods: This study involved the retrospective observational analysis of the Japan Medical Data Center (JMDC, Tokyo, Japan) database, an anonymized patient-level claims database younger than 75 years old. We identified cases with diagnosis and treatment of MM with codes provided by JMDC. Patients with a tentative diagnosis code of MM [C90] were included. Cases with a history of VTE or a pre-diagnostic history of fewer than six months were excluded. Propensity score (PS) was calculated using logistic regression based on age, gender, and cardiovascular risk factors. Results: We identified 2,023 eligible cases (mean age 53.6 ± 11.8 years) between January 2015 and December 2020. After 1:1 PS matching, the number of patients, mean age (years), follow-up (months) were as follows: MM group (n=280, 58.7 ± 8.1, 18.6 ± 14.8), Control group (n=280, 58.5 ± 8.1, 24.4 ± 18.4). Kaplan-Meier analysis indicated that the rate of VTE within 60 months was significantly higher among MM than in Control (25.7% vs 2.5%, Log-rank p&lt;.001). Within the MM group, multivariable Cox proportional hazard model showed that lenalidomide had a risk of VTE (Hazard Ratio 1.16 [95% Confidence Interval: 1.19-7.69]) among modern therapies (stem cell transplantation 37.1%, elotuzumab 6.4%, daratumumab 16.8%, bortezomib 88.9%, carfilzomib 21.8%, ixazomib 11.8%, thalidomide 3.9%, lenalidomide 78.9%, and pomalidomide 15.4%). Conclusions: Patients who underwent modern MM therapies, including immunomodulatory agents, had significantly higher VTE risk than PS-matched Control. Therefore, further studies using real-world data to improve prevention, early detection, and treatment of MM-related VTE are warranted.
Abstract 13468: Dietary Intake of Minerals and Risk of Cardiovascular Mortality in the Golestan Cohort Study
Authors: Mohammad Hosein Yazdanpanah, Adriana Torres, Maryam Sharafkhah, Hossein Poustchi, Arash Etemadi, Farin Kamangar, Sanford M Dawsey, Christian C Abnet, Maryam Hashemian, Reza Malekzadeh
Journal: Circulation (2022)

Introduction: Several studies have linked cardiovascular disease (CVD) to dietary intake of a few minerals, although the link is still unclear, and the findings may not apply to various populations. In a prospective study in a Middle Eastern population, we aimed to assess the relationship between dietary intakes of calcium, selenium, zinc, iron, magnesium, and copper and the risk of CVD mortality. Methods: We used data from the Golestan Cohort Study, which has followed 50,045 participants aged 40-75 years since 2004. We excluded subjects reporting extreme intakes of total energy and a positive history of cancer, CVD, or diabetes at baseline. Mineral intake was estimated from the baseline food frequency questionnaire. Supplement use was not common in this population. Mineral intakes were adjusted by the nutrient density method. We used Cox proportional hazards models to estimate hazards ratio (HR) and 95% confidence intervals (CI) for cardiovascular mortality using the lowest quintile of intake as a reference group for each mineral with adjustment for potential confounders. Results: We analyzed 41,863 subjects that had a mean age of 51.5+8.7 years at baseline . During 579,339 person-years of follow-up (median: 14.1 Years), 3,065 (7.22%) participants died due to CVD. Calcium was the only mineral with a mean intake below the US Recommended Dietary Allowance. We observed significant associations between calcium intake (HR Q5 vs Q1 =0.82, 95% CI=0.73-0.93), selenium intake (HR Q5 vs Q1 =1.14, 95% CI=1.01-1.29), and CVD mortality (P-values &lt;0.05). We observed no statistically significant associations with zinc (HR Q5 vs Q1 =1.10, 95% CI=0.98-1.24), iron (HR Q5 vs Q1 =1.08, 95% CI=0.96-1.22), magnesium (HR Q5 vs Q1 =1.01, 95% CI=0.90-1.14), or copper (HR Q5 vs Q1 =1.11, 95% CI=0.99-1.26) intake and CVD mortality. When modeled as continuous linear variables, iron and copper intake were associated greater risk of CVD mortality (P-values&lt;0.05). Conclusion: Dietary calcium intake was associated with decreased, whereas selenium and possibly copper intake were associated with increased risk of CVD mortality in this Middle Eastern population.
Abstract 14568: Recognition of Cardiovascular Disease Related Risk Factors, Eligibility and Completion of Recommended Health Checks Among Australian Adults
Authors: Lucy C Nijam
Journal: Circulation (2022)

Introduction: Cardiovascular disease (CVD) is a leading cause of death in women globally. Risk factors include hypertension (HTN), hyperlipidaemia, high body mass index (BMI), diabetes, poor mental health and health literacy. Early identification and management of risk factors is imperative, given that CVD in women is often under-recognised. Methods: Using selected social media platforms a survey was conducted among adult Australians (&gt;18yrs) in 2019, evaluating knowledge of risk factors for CVD, eligibility and completion of Australian Guideline recommended health checks. Results: Amongst 229 respondents 77% (177/229) were women. 62% of women (111/177) and 71% of men (37/52) were under the age of 44 years. Women reported a mean of 5/12 risk factors and men reported a mean of 7/12 risk factors for CVD. Women were more likely to report family history compared to men (29.3%, 52/177; vs 9.61%, 5/52; p=0.001), hyperlipidaemia (29.3%, 52/177; vs 11.5%, 6/52; p=0.004), high BMI (37.85%, 67/177 vs 23%, 12/52 p=0.002), HTN (18%, 32/177; vs 5.76%, 3/52; p=0.015) and an unhealthy diet (35%, 62/177; vs 27%, 14/52; p=0.1382). Women were less likely to report inactivity (33% 59/177, vs 36.5%, 19.52; p=0.334). Smoking was the most frequently reported risk factor by both sexes (40.3%, 74/177 and 41.8%, 21/52; p=0.427). Fewer women were aware of eligibility for a blood pressure check (9.6%, 17/177; vs 11.5%, 6/52; p=0.341), cholesterol (13%, 9/66; vs 33%, 5/15; p=0.034) and weight check (0%, 0/177; vs 2%, 1/52; p=0.033). Awareness of eligibility for a diabetes check was similar between the sexes (12%, 8/66 in women vs 11%, 1/15 in men; p=0.272). More women had completed a blood pressure (71%, 126/177; vs 65%, 32/52; p=0.093) and weight check (34%, 61/177; vs 32%, 17/52; p=0.406) than men however less women had completed a cholesterol (52%, 34/66; vs 60%, 9/15; p=0.276) and diabetes check (21%, 14/66; vs 33%, 5/15; p=0.159). Conclusion: This pilot study found that knowledge of CVD risk factors and eligibility for health checks was low &amp; risk factor profiles differed significantly between the sexes. Future studies evaluating a larger cohort are needed to further assess the significance of sex-based differences in awareness to risk factors, eligibility and completion of health checks.
Abstract 15877: Understanding the Mechanisms of Ultrasound-Targeted Microbubble Cavitation-Mediated Blood Brain Barrier Opening
Authors: Grace E Conway, Anurag N Paranjape, Xucai Chen, Flordeliza S Villanueva
Journal: Circulation (2022)

Introduction: Stem cell and AAV-gene therapies are exciting new treatments for neuronal regeneration after ischemic stroke, but they have yet to become the standard of care. One challenge for these therapies is penetrating the blood brain barrier ( BBB ). Ultrasound-targeted microbubble cavitation ( UTMC ) using contrast agents (microbubbles, MB ) and ultrasound ( US ) applied to the brain is being explored to transiently open the BBB. While UTMC-mediated BBB opening is a promising delivery strategy, its underlying mechanisms are poorly understood. We hypothesize that tight junctions ( TJ ) play a role in mediating BBB permeability after UTMC. Methods: We utilized transwells with murine brain endothelial cells ( EC ) and astrocytes on opposite sides of a support membrane. US (1 MHz, 10 μs duration, 10 ms pulse interval) at 250 kPa was applied for 20 sec to MB in contact with ECs. Permeability was assessed using dextran. Immunofluorescence with staining for CD-31 (EC) and ZO-1 (TJ) was performed on transwells fixed 15 and 60 min after UTMC. Z-stacks of the transwells were acquired via confocal microscopy to measure paracellular gap area and mean voxel intensity of ZO-1. Data was normalized per EC. Unpaired 2-tailed t -test with correction for multiple t-tests were performed. Results: UTMC increases dextran flux across the BBB (p&lt;0.05). As shown in Figure 1, compared to no UTMC, there is an increase in paracellular gap area per cell (p&lt;0.05). From 15 to 60 min after UTMC, there is a decrease in gap area (p=0.056) and an increase in the mean voxel intensity of ZO-1 per EC (p&lt;0.05). Conclusions: UTMC increase BBB permeability through paracellular gaps. Between 15 and 60 min after UTMC, there is closure of some paracellular gaps and a re-establishment of endothelial TJ in this model of the BBB. Understanding the mechanisms mediating the changes in the BBB after UTMC should facilitate the development of UTMC as a delivery strategy for cell or gene-based therapeutics to enhance recovery after stroke.
Abstract 15642: Transient Brugada Pattern in an Afebrile Patient With Covid Myocarditis
Authors: Olalekan Olanipekun, Esiemoghie Akhigbe, Utsab Panta, Riya Sam, Kelechukwu Okoro
Journal: Circulation (2022)

Introduction: SARS-CoV2 infection has been associated with cardiovascular manifestations, including myocarditis and arrhythmias. Asymptomatic brugada pattern of EKG has been reported and usually associated with fever, sodium channel blockers, and psychotropic drugs. There have been few reported cases of brugada pattern unmasked by fever in patient with covid-19 infection. We present a unique case of a patient with brugada pattern of EKG in an afebrile patient with Covid 19 myocarditis. Case presentation: Patient is a 58 year old male with PMHx significant for ITP, HTN who was admitted on account of dyspnea and dysphagia. Patient was subsequently with covid-19 infection/pneumonia and epiglottitis. Decision Making: Physical examination findings showed a hyperemic epiglottis. Initial labs were positive for covid 19 with elevated troponins (&gt;3000). Initial EKG showed ST elevation on V1-V4 (figure 1a) raising suspicion for possible STEMI vs covid myocarditis with brugada pattern. Echocardiogram performed showed a severely reduced ejection fraction at 20% with global hypokinesis. Emergent left heart catherization was performed which showed no angiographic evidence of coronary artery disease. The patient was started on guideline therapy for covid 19 infection and also antibiotics for presumed epiglottitis. Inflammatory markers continued to trend downwards. Patient was also started on guideline directed medical therapy for heart failure. Repeat EKG showed resolution of Brugada pattern (figure 1c). Clinical course improved throughout hospital stay. Conclusion: There has been few reported cases of brugada pattern un-masked by Covid-19 infection. These reported cases are commonly associated with the occurrence of fever, which has been attributed to the dysregulation of Na channels. This case presents a diagnostic dilemma as most patient with covid and brugada have documented febrile episodes prior to the unmasking of this rare arrhythmia.
Abstract 15381: Phlegmasia Cerulea Dolens and Concurrent Gastrointestinal Bleeding: A Dangerous Combination With Challenging Management
Authors: Gian Lima, Yitzchok S Lederman
Journal: Circulation (2022)

Introduction: Phlegmasia cerulea dolens (PCD) is a rare and life-threatening complication related to extensive deep venous thrombosis (DVT) resulting in acute limb ischemia. Treatment options include anticoagulation, thrombolysis and thrombectomy. Case: A 31-year-old female with a history of ulcerative colitis (UC) on chronic steroids presented with acute dyspnea and tachycardia. She was hemodynamically stable. The initial workup included a lower extremity (LE) Doppler ultrasound (US) which showed an acute occlusive thrombus involving the left posterior tibial and popliteal veins, and a computerized tomography angiography (CTA) of her chest which showed bilateral pulmonary emboli. She was placed on heparin drip for 48 hours but due to an episode of acute gastrointestinal (GI) bleeding due to severe UC, anticoagulation was discontinued after an inferior vena cava filter placement and she was discharged from the hospital. After 1 month, she presented with severe diarrhea, hypotension and tachycardia. A chest CTA showed reduced clot burden compared to prior. On hospital day 2, the patient experienced acute onset of severe left LE pain, bluish skin discoloration and rapidly progressing edema. A repeat US showed progression of DVT to the left common femoral vein. The findings were consistent acute limb ischemia in the setting of PCD. She was managed with emergent thrombectomy, with significant amount of thrombus retrieved. Gastroenterology was consulted and GI bleeding did not recur. Discussion: Due to its rarity, there are limited data available to guide PCD management in the setting of elevated bleeding risk such as severe UC. However, after a risk-benefit assessment, we determined that this young patient should be treated with anticoagulation and undergo emergent thrombectomy, which resulted in significant improvement of her symptoms. We highlight the importance of multidisciplinary approach, early diagnosis and prompt treatment in these complex patients.
Abstract 14784: Outcomes Associated With Implementation of an Intravenous Sotalol Initiation Protocol
Authors: Albert Y Liu, Jessica Charron, Dana Fugaro, Scott Spoolstra, Rachel Kaplan, Graham Lohrmann, Xu Gao, Hawkins Gay, Rod S Passman, Susan Kim, Albert Lin, Alexandru Chicos, Rishi Arora, Kaustubha Patil, Anna Pfenniger, Bradley P Knight, Nishant Verma
Journal: Circulation (2022)

Introduction: Oral sotalol initiation frequently requires a multi-day hospitalization for electrocardiographic monitoring. A one-day intravenous (IV) sotalol loading protocol was approved by the FDA in March 2020, but limited data on its clinical use currently exists. The aim of this study was to describe the outcomes of implementation of the IV sotalol initiation protocol within an integrated health system. Methods: An IV sotalol loading protocol was started in August 2021 for adult patients who were candidates for oral sotalol and had a creatinine clearance (CrCl) &gt; 30 mL/min. Patients with a heart rate &lt; 60 bpm or QTc &gt; 450 ms (500 ms for those with widened QRS) were excluded. Patients with persistent atrial arrhythmias were cardioverted prior to drug infusion. IV sotalol infusion was administered in the Cardiac Recovery and Observation Unit with one-on-one nursing and was stopped for a heart rate &lt; 50 bpm or QTc &gt; 500 ms (550 ms for those with widened QRS). Patients were admitted for monitoring post-infusion and received two oral sotalol doses prior to discharge. Serial EKGs were performed according to protocol. Expected length of stay (LOS) with oral initiation was calculated for the same patients using CrCl. Results: A total of 27 patients (average age 66 years, 26% women) underwent IV sotalol initiation. Average LVEF was 52% and average CrCl was 91.4 ± 24.8 mL/min. Primary indication was atrial arrhythmia for 74% and ventricular arrhythmia for 26%. Sotalol loading was successfully completed in 21 (78%) patients. Adverse events interrupting sotalol load included bradycardia (5 patients, 19%) and QT prolongation (2 patients, 7%). No patients developed sustained ventricular arrhythmias. LOS for patients completing IV load was 2.3 days shorter (mean 1.0 vs 3.3, p&lt;0.001) compared to expected LOS with oral load. Conclusions: A one-day IV sotalol loading protocol is a safe alternative to a multi-day oral sotalol initiation protocol and significantly shortens hospital LOS, potentially leading to significant cost savings.
Abstract 13478: Observatory of Hospitalizations and Mortality in 37 Cardiology Departments in 17 Sub-Saharan African Countries: The February Study From African Research Network
Authors: Roland N'GUETTA, Valentin Yameogo, Pauline Cavagna, Ichaka Menta, Elsa Ayo Bivigou, Charles Kouam Kouam, Marie-Cécile PERIER, Abdoulaye K Traore, Jolis Nzisabira, Martin Dèdonougbo Houenassi, Jean Laurent Takombe, Aliou Alassane Ngaide, Lucien Allawaye, Ibrahima Bara Diop, marie antignac, Xavier JOUVEN
Journal: Circulation (2022)

Non-communicable diseases represent the second common cause of death in Sub-Saharan Africa (SSA) accounting for 50% of deaths in several countries. Furthermore, 80% of cardiovascular diseases (CVD) deaths occurs in low and middle-income countries. Data regarding the characteristic of patients with CVDs are scarce in SSA. To describe hospital admission for CVD and care components in 17 in SSA countries. We conducted a transversal and longitudinal study in CV departments of 37 hospitals (public and private) in 17 SSA countries. The February study is an ongoing observatory included all inpatients in February from each year since 2016. Data including socio-demographic and clinical characteristics, CV risk factors, causes of admission, medication and length of stay were collected during hospitalization by the investigating physicians. Patient wealth index was assessed by physicians as low, middle and high according to patient capacity to afford hospitalization. All analyses were performed with random effect on countries and through scripts developed in the R software 4.0.3. Overall, 4360 in-hospital patients were included in the February study, the mean age was 56.7 ± 16.8 years, and 56.4 % were men. Individual wealth index was low, middle and high in 1158 (27.7%), 1812 (43.4%) and 1203 (28.8%) patients, respectively. The main cause of hospital admission was heart failure (41.5%)(figure) followed by acute coronary syndrome (11.9%) and stroke (11%). Causes of admission varied significantly across countries and over years. Overall, 73.8% of patients had at least one CV risk factors and hypertension (≥ 140±90mmHg) was noticed in 55.2% of patients. Average length of stay was 10 days. Mortality rate was 11% and did not vary over time but was significantly different according to patient wealth index (p&lt;0.05) consistent by sex, age, and type of hospital.The February observatory provides reliable data in SAA. High rate of hospitalization mortality remain open to investigation.